Test results Hgb 77 g/L MCV 66f/L RBC 3.2 x1012/L WBC 5.6 x106/L Plat 525 x109/L

Blood film

This is a 55 year old woman who has fatigue. Her only other symptom is a craving for chewing ice cubes. Apartfrom being pale her examination is normal.

Which one of the following tests would best define the type of anemia she has ?

A. Hgb electropheresis

B. Serum iron and iron-binding capacity

C. Serum ferritin

D. Serum transferrin

E. Bone marrow iron

Test results Hgb 135 g/L MCV 65 fL RBC 5.4 x1012/L WBC 6.5 x106/L Plat 355 x109/L

Blood film

A 44 year old executive is sent to you for an insuranceexamination. He is fit, but on examination he has mild hypertension.

Test results Hgb 135 g/L MCV 65 fL RBC 5.4 x1012/L WBC 6.5 x106/L Plat 355 x109/L

Blood film microcytosis hypochromia target teardrop basophilic stippling

A 44 year old executive is sent to you for an insuranceexamination. He is fit, but on examination he has mild hypertension.

Which test is likely to give a diagnosis in this case ?

A. Serum ferritin

B. Serum transferrin

C. Sickle Cell screen

D. Hgb electropheresis

E. Liver function tests

Test results- Hgb 99 g/L- MCV 100 fL- RBC 3.7 x1012/L- WBC 3.4 x106/L- Plat 117 x109/L- Retic count: elevated

- bili 35 mol/L

This is an 18 year old boy who you are investigating forJaundice. He has this intermittently for some time. Hisfamily are Christian Scientists. Physical exam shows jaundice and splenomegaly

Which of the following would be most helpful in identifying this young man’s problem ?

A. Reticulocyte count

B. Osmotic fragility test

C. DAT (Coomb’s test)

D. Bone marrow test

E. Family studies

Test results- Hgb 99 g/L- MCV 100 fL- RBC 3.7 x1012/L- WBC 3.4 x106/L- Plat 117 x109/L

- bili 35 mol/L - blood film- polychromasia- spherocytes

This is an 18 year old boy who you are investigating forJaundice. He has this intermittently for some time. Hisfamily are Christian Scientists. Physical exam shows jaundice and splenomegaly

Test results Hgb 142 g/L MCV 105 fL RBC 4.9 x1012/L WBC 6.7 x106/L Plat 105 x109/L

Blood Film

A 46 year old diplomat is referred to you because of abnormal blood results. On review of these you suspect the cause and order appropriate blood tests.

Test results Hgb 142 g/L MCV 105 fL RBC 4.9 x1012/L WBC 6.7 x106/L Plat 105 x109/L

Blood FilmMacrocytosisTarget cellsstomatocytes

A 46 year old diplomat is referred to you because of abnormal blood results. On review of these you suspect the cause and order appropriate blood tests.

What tests would you order on receiving these results ?

A. Serum B12 and folate

B. Bone marrow aspirate

C. Serum lipid studies

D. Liver function tests

E. Thyroid function tests

Test results Hgb 85 g/L MCV 110 fL RBC 3.9 x1012/L WBC 2.4 x106/L Plat 89 x109/L Retic count low

A 65 year old woman is referred to you because of memoryloss. Her family physician had received tests which included bilirubin of 28 mol/L and an LDH of 1560 U/L. He waspuzzled by these results.

Test results Hgb 85 g/L MCV 110 fL RBC 3.9 x1012/L WBC 2.4 x106/L Plat 89 x109/L

Blood FilmMacrocytosisoval macroyteshypersegmentedneutrophils

A 65 year old woman is referred to you because of memoryloss. Her family physician had received tests which included bilirubin of 28 mol/L and an LDH of 1560 U/L. He waspuzzled by these results.

Which one of the following tests is most appropriate ?

A. Liver function

B. Thyroid function

C. RBC folate

D. Serum B12

E. Bone marrow aspirate

Test results Hgb 103 g/L MCV 99 fL RBC 3.8 x1012/L WBC 3.4 x106/L Plat 125 x109/L Retic ‘normal’

A 65 year old woman complains of back pain. Her X-raysshow diffuse osteoporosis. She also complains of increasedthirst and drowsiness.

Test results Hgb 103 g/L MCV 99 fL RBC 3.8 x1012/L WBC 3.4 x106/L Plat 125 x109/L

Blood Filmrouleauxbackground

staining

A 65 year old woman complains of back pain. Her X-raysshow diffuse osteoporosis. She also complains of increasedthirst and drowsiness.

Which one of these tests would most likely lead to the diagnosis ?

A. Serum osmolarity

B. Serum viscosity

C. Serum protein electrophersis

D. Serum TSH

E. Serum PTH

Test results Hgb 115 g/L MCV 115 fL RBC 2.2 x1012/L WBC 8.4 x106/L Plat 246 x109/L Retic count:

elevated

You admit a 36 year old woman with pneumonia. She hasfever, shortness of breath and requires oxygen. She is also noted to be anemic.

Test results Hgb 115 g/L MCV 115 fL RBC 2.2 x1012/L WBC 8.4 x106/L Plat 246 x109/L

Blood FilmRBC agglutination

You admit a 36 year old woman with pneumonia. She hasfever, shortness of breath and requires oxygen. She is also noted to be anemic.

These test results would help you choose which one of these antibiotics ?

A. Cephalexin

B. Penicillin G

C. Azithromycin

D. Sulfamethoxazole

E. Ciprofloxacin

Test results Hgb 75 g/L MCV 107fL RBC 2.8 x1012/L WBC 8.9 x106/L Plat 377 x109/L

Blood Film

An 18 year old woman has symptoms of cystitis. After urinecultures are taken she is given Sulfamethoxazole. Her urinarysymptoms improve but she becomes short of breath. A weeklater on follow-up her investigation shows.

Test results Hgb 75 g/L MCV 107fL RBC 2.8 x1012/L WBC 8.9 x106/L Plat 377 x109/L

Blood Filmpolyychromasiablisterbite cells

An 18 year old woman has symptoms of cystitis. After urinecultures are taken she is given Sulfamethoxazole. Her urinarysymptoms improve but she becomes short of breath. A weeklater on follow-up her investigation shows.

What type of anemia is causing this problem ?

A. An idiosyncratic drug reaction

B. An allergic drug reaction

C. Marrow suppressive effect

D. Immune hemolysis

E. Oxidative hemolysis

Test results Hgb 115 g/L MCV 91 fL RBC 4.1 x1012/L WBC 14.5 x106/L Plat 52 x109/L

You are called to see this 29 year old primip in the case room. The obstetrician is concerned about her platelet count. She is well but a bit hypertensive.

Test results Hgb 115 g/L MCV 91 fL RBC 4.1 x1012/L WBC 14.5 x106/L Plat 52 x109/L

Blood Filmpolychromasiarbc fragmentsthrombocytopenia

You are called to see this 29 year old primip in the case room. The obstetrician is concerned about her platelet count. She is well but a bit hypertensive.

What diagnosis is most likely ?

A. ITP ( immune thrombocytopenia )

B. TTP ( thrombotic thrombocytopenic purpura)

C. PIH (pre-eclampsia)

D. Benign thrombocytopenia of pregnancy

E. DIC (disseminated intravascular coagopathy)

Test results Hgb 115 g/L MCV 105 fL RBC 3.8 x1012/L WBC 9.2 x106/L Plat 420 x109/L

Blood Film

This 35 year old man is sent to you because of unusual blood results. His complaints are of fatigue and an episodicitchy rash.

Test results Hgb 99 g/L MCV 96 fl RBC 3.4 x1012/L WBC 3.65 x106/L Plat 560 x109/L Retic: low

You are asked to asses a 72 year old woman for anemiaand splenomegaly. She has been losing weight for 1 year.She has had 2 episodes of gout.

Test results Hgb 99 g/L MCV 96 fl RBC 3.4 x1012/L WBC 3.65 x106/L Plat 560 x109/L

Blood Filmthromboytosistear drop cellsleukoerythroblstic

You are asked to asses a 72 year old woman for anemiaand splenomegaly. She has been losing weight for 1 year.She has had 2 episodes of gout.

What test would give a definitive diagnosis ?

A. LAP score

B. Osmotic fragility

C. Hgb electropheresis

D. Bone scan

E. Bone marrow biopsy

…splenomegaly Hematologic conditions

– Myelofibrosis– Some hemolytic anemias– Myeloproliferative conditions– leukemia– Lymphomas

Non-hematologic– Congestive (cirrhosis)– Infiltrative: malignant, non-malignant– Infectious (mono)– Inflammatory:

Lymphadenopathy

Abnormal in size, consistency, number Generalized Localized

uptodate

Test results Hgb 136 g/L MCV 88 fL RBC 4.9 x1012/L WBC 17.3 x106/L Plat 110 x109/L

Blood Film

This 24 year old man has acute abdominal pain. He has notbeen feeling well for 5 days. After a baseball game he hadacute upper abdominal pain and was quite tender in the upper abdomen. The surgeon asks you to see the patient.

Test results Hgb 136 g/L MCV 88 fL RBC 4.9 x1012/L WBC 17.3 x106/L Plat 110 x109/L

Blood Filmvariant lymphocytesatypicalreactive

This 24 year old man has acute abdominal pain. He has notbeen feeling well for 5 days. After a baseball game he hadacute upper abdominal pain and was quite tender in the upper abdomen. The surgeon asks you to see the patient.

What is the disorder most likely responsible for his condition ?

A. Acute leukemia

B. Pancreatitis

C. Malaria

D. Infectious mononucleosis

E. Liver abcess

Test results Hgb 139 g/L MCV 93 fL RBC 5.1 x1012/L WBC 29 x106/L Plat 178 x109/L

Blood Film

This 55 year old man is referred for unexplained elevatedWhite cell count. He feels well. Examination is normal.

Test results Hgb 139 g/L MCV 93 fL RBC 5.1 x1012/L WBC 29 x106/L Plat 178 x109/L

Blood FilmLymphocytosisSmudge cells

This 55 year old man is referred for unexplained elevatedWhite cell count. He feels well. Examination is normal.

What test would confirm your diagnosis ?

A. Mono spot test

B. LAP score

C. Bone marrow biopsy

D. Immunophenotyping

E. Skeletal survey

Test results Hgb 92 g/L MCV 81 fL RBC 3.4 x1012/L WBC 5.2 x106/L Plat 13 x109/L

Blood Film

This 36 year old man is admitted to hospital with generalizedbruising and bleeding. He is febrile. There are many bruisesand petichia present.

Test results Hgb 92 g/L MCV 81 fL RBC 3.4 x1012/L WBC 5.2 x106/L Plat 13 x109/L

Blood FilmCytopeniasBlasts

This 36 year old man is admitted to hospital with generalizedbruising and bleeding. He is febrile. There are many bruisesand petichia present.

What disease is most responsible for his condition ?

A. Septicemia

B. Drug reaction

C. Infectious mononucleosis

D. Chronic leukemia

E. Acute leukemia

This is a 35 year old male who is found to have persistent leukocytosis. His family physician wants you to rule out a Chronic leukemia. Test ResultsÄ HGB 146 g/LÄ MCV 92 fLÄ RBC 5.5x1012/LÄ WBC 25X106/LÄ Plat 465x109/L

Blood Film

This is a 35 year old male who is found to have persistent leukocytosis. His family physician wants you to rule out a Chronic leukemia. Test ResultsÄ HGB 146 g/LÄ MCV 92 fLÄ RBC 5.5x1012/LÄ WBC 25X106/LÄ Plat 465x109/L

Blood Film Normocytic Normochromic Neutrophilia Metamyelocyte

What test would be most cost effective in helping to establish a diagnosis ?

A. Immunophenotyping

B. Leukocyte alkaline phosphatase

C. Bone marrow aspirate

D. Cytogenetics

E. Blood cultures

A 25 year old female university student is found to have a very low hemoglobin. She in fact feels fairly well. Physical exam shows pallor only. Test ResultsÄ HGB 7.1 g/LÄ MCV 80 fLÄ RBC 2.7x1012/LÄ WBC 6.3x106/LÄ Plat 345x109/L

Blood Film

A 25 year old female university student is found to have a very low hemoglobin. She in fact feels fairly well. Physical exam shows pallor only. Test ResultsÄ HGB 7.1 g/LÄ MCV 80 fLÄ RBC 2.7x1012/LÄ WBC 6.3x106/LÄ Plat 345x109/L

Blood Film Irreg contracted Burr cells

Which test do you think will give the diagnosis ?

A. Iron studies

B. Reticulocyte count

C. Endocrine studies

D. Liver function

E. Renal function

A 50 y.o male presents with an elevated hematocrit, splenomegaly, and pruritus

following shower Test results

– Hb 195, HCT 0.60– Platelets 500– WBC 7.0

A. iron studies B. B12 levels C. Serum epo D. Jak 2 mutation testing E. BCR-ABL testing

Which test is indicated?